| 不同剂量右美托咪定对食管癌根治术患者术后谵妄的作用 |
| 投稿时间：2016-01-05 修订日期：2016-02-11 点此下载全文 |
| 引用本文：李英娜,刘志建,黄泽清.不同剂量右美托咪定对食管癌根治术患者术后谵妄的作用[J].医学研究杂志,2016,45(9):141-144,84 |
| DOI：
10.11969/j.issn.1673-548X.2016.09.037 |
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| 中文摘要:目的 评价不同剂量右美托咪定（Dex）对食管癌根治术患者术后谵妄的作用。方法 择期行食管癌根治术的患者90例，采用数字表法将患者随机分为Dex低剂量组（Dex-L组）、Dex高剂量组（Dex-H组）和生理盐水组（NS组），每组30例。Dex-L组、Dex-H组患者分别静脉泵注Dex负荷量0.5μg/kg、1.0μg/kg，10min泵注完毕，后分别以维持量0.3μg/（kg·h）、0.5μg/（kg·h）继续泵注至手术结束前30min；相同时间内NS组患者静脉输注等量生理盐水。Dex负荷量泵注结束后开始麻醉诱导。分别观察麻醉诱导前（T0）、诱导后10min（T1）、单肺通气1h（T2）、手术结束后1h（T3）、6h（T4）、24h（T5）、48h（T6）和72h（T7）时抽取颈内静脉球部血液，测定颈静脉球部血氧饱和度（SJvO2）和血氧分压（PJvO2），并检测T0、T3、T5~T7时血清中星型胶质细胞S-100β蛋白（S-100β蛋白）和神经元特异性烯醇化酶（NSE）水平；采用ICU意识障碍评估法（CAM-ICU）评估患者术后72h谵妄发生率。结果 与NS组比较，Dex-L组和Dex-H组SJvO2及PJvO2分别在T1时点明显降低（P<0.01）；与NS组和Dex-L组比较，Dex-H组SJvO2及PJvO2分别在T2~T7时点明显升高（P<0.01）。与NS组和Dex-L组比较，Dex-H组S-100β蛋白及NSE水平分别于T3、T5~T7时均降低（P<0.01）。与NS组和Dex-L组比较，Dex-H组患者术后72h谵妄发生率明显降低（P<0.05）。结论 1.0μg/kg剂量的Dex可明显降低食管癌根治术患者术后谵妄的发生率，其作用机制可能与其降低脑组织氧耗量、减轻脑损伤有关。 |
| 中文关键词:右美托咪定 谵妄 食管癌根治术 术后并发症 |
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| Effects of Different Dosage of Dexmedetomidine on Postoperative Delirium of Patients Undergoing Radical Surgery for Esophageal Carcinoma |
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| Abstract:Objective To investigate the effects of different dosage of dexmedetomidine (Dex) on postoperative delirium of patients undergoing radical surgery for esophageal carcinoma. Methods Ninety patients, aged 60-70 years, classified as ASA from Ⅰ to Ⅱ and scheduled for selective radical surgery for esophageal carcinoma, were randomly allocated into three groups (n=30): low dosage of Dex group (Dex-L group), high dosage of Dex (Dex-H group) and normal saline group (NS group). Before anesthesia induction, Dex [0.5μg/kg bolus or 1.0μg/kg bolus and infusion at a rate of 0.3μg/(kg·h) or 0.5μg/(kg·h)] was administered to the patients of Dex-L group or Dex-H group, while the patients of NS group were given with equivalent normal saline at the same time. Jugular venous oxygen saturation (SJvO2) and jugular venous oxygen partial pressure (PJvO2) were performed before anesthesia induction (T0), at 10min after induction (T1), at 1h after one-lung ventilation (T2), at 1h (T3), 6h (T4), 24 h (T5), 48h (T6), 72h (T7) after operation finished. The levels of S-100 beta protein (S-100 beta protein) of radial glial cells and neuron specific enolization enzyme (NSE) in serum were determined at T0, T3, and from T5 to T7. The prevalence of delirium was estimated daily for 72h via the confusion assessment method for intensive care. Results Compared to NS group, SJvO2 and PJvO2 of Dex-L group and Dex-H group at T1 were markedly lower (all P<0.01). Compared to NS group and Dex-L group, SJvO2 and PJvO2 of Dex-H group from T2 to T7 were obviously higher (all P<0.01). Compared to NS group and Dex-L group, the levels of S-100 beta protein and NSE of Dex-H group were lower (all P<0.01) at T3 and from T5 to T7. Compared to NS group and Dex-L group, the prevalence of delirium of Dex-H group was lower (P<0.05) within 72h after operation . Conclusion Dex at a dose of 1.0μg/kg is associated with significantly lower rates of delirium of elderly patients undergoing radical surgery for esophageal carcinoma, and the mechanism may be involved in decreasing oxygen consumption in brain tissue and alleviating alleviating brain injury. |
| keywords:Dexmedetomidine Delirium Radical surgery for esophageal carcinoma Postoperative complication |
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